The diversion and abuse of methadone, a drug commonly used
to treat heroin and other opiate addiction, appear to be increasing
throughout the country. Drug Abuse Warning Network data reveal a rise in
the number of methadone-related emergency department mentions, and many
law enforcement agencies report increased occurrences of methadone abuse
in their jurisdictions. This rise in methadone abuse corresponds to an
increase in methadone availability. According to the Drug Enforcement
Administration, the amount of methadone distributed by retail-level
hospitals, retail pharmacies, practitioners, midlevel practitioners, and
teaching institutions has increased from 692,675 grams in 1998 to
1,892,691 grams in 2001, the latest year for which data are available.
Most methadone is used legitimately to treat opiate addiction and to
relieve chronic pain; however, some is diverted and sold for illicit use.
The number of methadone abusers who use the drug solely for its potential
euphoric effect appears to be very low. Rather, those abusing methadone
likely include chronic heroin users and a growing number of oxycodone
abusers--particularly abusers of OxyContin, Percodan, and Percocet--seeking
to ameliorate the effects of opiate withdrawal.

Methadone, a Schedule II drug under the Controlled
Substances Act, is a long-lasting synthetic opioid that, when used
properly, reduces cravings for opiates--a leading cause in opiate abuse
relapse. Methadone suppresses opiate cravings for 24 to 36 hours; thus,
the drug can be administered once a day for the treatment of opiate
addiction. Methadone also is prescribed as a narcotic analgesic to treat
chronic pain. When abused, particularly in combination with other drugs,
methadone causes effects in some users that are similar to those caused by
the abuse of heroin and other opiates. Over time legitimate and
illegitimate users may develop tolerance for and dependence on methadone.

Methadone is available in several forms including tablets,
dispersible tablets (dissolvable in water or juice), liquid, liquid
concentrate, and an injectable solution. Only practitioners certified by
the Substance Abuse and Mental Health Services Administration are
permitted to prescribe and dispense methadone for treatment of opiate
addiction. However, any physician may prescribe methadone as an analgesic
for treatment of chronic pain. When prescribed as an analgesic, methadone
may be dispensed by any licensed pharmacy.

According to DAWN, the number of emergency department
mentions for methadone increased overall from 3,832 in 1997 to 10,725 in
2001. Moreover, DAWN reports that 65 percent of methadone-related
emergency department episodes also involved other drugs or alcohol in
2001. In that year alcohol was the substance most frequently used in
combination with methadone, followed by cocaine and heroin.

DAWN mortality data for 2001 show that in most
methadone-related deaths the drug was used in combination with other
substances; however, those substances were not identified. Nevertheless,
the data show that methadone ranked among the top 10 drugs mentioned in
drug-related deaths in 24 of 33 DAWN reporting cities including Baltimore,
Chicago, Detroit, Newark, and Phoenix.

According to the National Drug Intelligence Center
National Drug Threat Survey 2003--a statistically representative
nationwide survey of state and local law enforcement agencies--nearly 33
percent of all state and local law enforcement agencies indicate that
methadone was commonly diverted or illicitly abused in their areas. Survey
data further show that a higher percentage of agencies (42.7%) in
southeastern states reported methadone abuse.

According to the Florida Department of Law Enforcement and
the Florida Office of Drug Control, increased methadone abuse in Florida
has resulted in an increase in overdose deaths involving the drug. The 2002
Report of Drugs Identified in Deceased Persons by Florida Medical
Examiners indicates that methadone was found in 556 of the 5,816
decedents whose deaths were drug-related. Of these, methadone was
determined to have contributed to the cause of death of 308 decedents.
Furthermore, the number of drug-related deaths involving methadone
increased 56 percent from 357 in 2001 to 556 in 2002, more than any other
drug included in the report.

In North Carolina the number of single-drug deaths
involving methadone--where methadone was determined to cause the death but
was not necessarily the only drug found in the decedent--increased overall
from 7 in 1997 to 58 in 2001. For all methadone-related deaths from 1997
to 2001, the source of the methadone was identified in 46 percent (92
deaths) of the medical examiner's reports. Of these deaths, 73 decedents
were found to have a prescription for methadone that had been written for
them by a physician; 11 had methadone from a prescription that had been
written for another person; 3 were known to have obtained their methadone
illegally, and 5 were reported as having a combination of prescription
methadone and methadone obtained illegally.

Methadone abuse also is a problem in other parts of the
United States. Medical examiner data from Maine indicate that methadone
increasingly is involved in overdose deaths. According to the report Maine
Drug-Related Mortality Patterns: 1997-2002, methadone was the
prescription drug most commonly identified in toxicology reports. The
report shows that the number of cases in which methadone was listed as the
cause of death or as a contributing factor fluctuated but increased
overall from 4 in 1997 to 14 in 2001. In the first 6 months of 2002, 18
deaths were reported in which methadone was a cause of death or
contributing factor. The report further indicates that in 2001 fewer than
half of decedents whose deaths were caused by methadone or in which
methadone was a contributing factor had a documented prescription for the
drug. Most of them had not been enrolled in a methadone maintenance
program. In 2001 an analysis of 14 cases in which methadone was a cause of
death or contributing factor statewide indicated that only three
individuals had been receiving treatment from a methadone maintenance
clinic.

Methadone often is diverted from opioid treatment
programs. When administered for opioid treatment, methadone typically is
dispensed under physician supervision in a methadone maintenance clinic.
However, federal law permits opiate treatment programs to dispense a
single take-home dose of methadone to patients for any day that the clinic
is closed, including Sundays and state and federal holidays. In addition,
treatment programs may dispense up to a 1-month supply of take-home doses
of methadone for patients who have been in treatment for an extended
period of time. Take-home doses of methadone sometimes are sold or traded
for other drugs including heroin. Methadone also is diverted through
misrepresentation and fraud. According to the Washington County Sheriff's
Office, some methadone patients in Maine mislead treatment providers into
prescribing more methadone than is actually needed. They ingest the amount
they need from their take-home doses and sell the remaining methadone for
approximately $1 per milligram.

Methadone prescribed to treat chronic pain may also be
diverted. Common diversion methods include fraudulent prescriptions,
actions of unscrupulous or inexperienced physicians and pharmacists, and
theft. On March 6, 2003, a Camp Springs, Maryland, dentist and a District
Heights, Maryland, pharmacist were indicted by a federal grand jury and
charged with illegally conspiring to dispense controlled substances
including methadone by issuing, presenting, and filling fraudulent and
stolen medical prescriptions.

Methadone diversion and abuse will likely continue to increase
as methadone is increasingly prescribed as an alternative to oxycodone for
chronic pain maintenance, and as more oxycodone abusers, particularly OxyContin,
Percodan, and Percocet abusers, seek relief from opioid withdrawal through
illegal means. This may require greater supervision of those patients in
methadone maintenance programs and, more importantly, increased scrutiny of
methadone prescribed for the treatment of chronic pain.